Aim of Investigation: According to the national and international guidelines patients with a certain chronic pain diagnoses (mainly widespread pain) should undergo multimodal rehabilitation based on the bio-psychosocial model. Recent reports remark the knowledge-gap in how to subgroup patients and its lack of evidence when matching the 'right' patient into the 'right' bio-psychosocial pain rehabilitation program. A first step in an evidence-based selection process is to increase knowledge about the patient. Based on the above the aim of this study included the following: 1. to map out the psychosocial characteristics of the patients referred to a pain rehabilitation clinic as reflected with the instruments included in the Swedish National Quality Registry of pain Rehabilitation (SQRP) 2. To study the differences between gender 3. If clinical significant dimensions of acceptance and fear of movement or other relevant areas (as diagnoses, etc.) can be differentiated and assessed with the instruments included in the SQRP. Methods: This study investigates 1371 patients' bio-psychosocial characteristics, their pain experience and gender differences when referred to an Acceptance & Commitment Therapy (ACT)-based pain specialty rehabilitation clinic. Self-report questionnaires included in the Swedish National Registry for Pain Rehabilitation were used: The Multidimensional Pain Inventory, The Chronic Pain Acceptance Questionnaire, Hospital Anxiety and Depression scale, The Tampa Scale for Kinesiophobia as well as three quality of life scales: the SF-36 Health Survey, Life Satisfaction Checklist (LiSat-11), and the EuroQol and sociodemographic and pain-related questions. Results yielded the following main findings. What is new: Significant gender-differences were found in the CPAQ-acceptance subscales. This has not been demonstrated previously. What is already known: The total group's bio-psychosocial characteristics and their experience of pain were in agreement with previous studies. The gender-differences in fear of movement were consistent with previous studies. What is different: Contrary with early research, there were no difference in depression and anxiety between men and women. What is important to keep in mind: The measures of dispersion (SD) gave strong indication that neither the total group nor the gender-divided subgroups were homogeneous. Further research on clinical relevant sub-groups determinant characteristics and differences is imperative. Conclusions: The overall group was quite representative for the pain population referred to a tertiary pain care in Sweden. The measures that could show distinct differences between men and women were pain acceptance and kinesiophobia. The well-established subscales of the MPI did not show any distinct differences between men and women. Newer constructs such as pain acceptance with its two subscales are interesting in that they are less pathological and stigmatizing than other constructs and probably easier to actively influence and change in the ACT-based rehabilitation model. One aspect to take in account is that these constructs, taken alone, explain uni-modal behavioral dimensions. Further research is needed in order to find multidimensional compound-assessment or clusters including these constructs today targeted in the ACT-based and multimodal pain rehabilitation programs offered now in Sweden.

Background: Chronic pain has great impact on individual and society with yearly costs of 87.5 billion SC. Psychosocial and behavioral factors are demonstrated to influence the experience and chronification of pain, but in Argentina this condition is still treated invasively and phamacologically. Pain does not only consist of a physical sensation, but also psychosocial and behavioral components that need to be considered. Aim: Map out patients’ psychosocial status and gender differences. Study the relationship between the main psychosocial variables. Methods: consecutively recruited patients with widespread pain (n=22) at a University hospital pain clinic answered questionnaires included in the Swedish Quality Registry of Pain Rehabilitation, about pain, socidemographics, anxiety and depression (HAD), QoL (SF-36), kinesophobia (TSK-11) and pain-acceptance (CPAQ). Non-parametric tests; Spearman’s rho, Fisher’s exact test, Mann-Whitney U-test, Kruskal-Wallis test were computed with SPSS. Results: The patients median age was 55, 77% of them were women, well-educated and half of them working. They had severe pain in several locations and experienced more restriction in daily activities. Mild levels of anxiety and kinesophobia but low levels of depression and decreased QoL was found. Pain-acceptance was correlated with anxiety, kinesophobia and some areas of QoL. The CPAQ subscale ’pain willingness’ was correlated to all psychosocial dimensions except kinesiophobia. No correlations found with health-care use. Conclusion: Results demonstrate need for a shift to biopsychosocial assessment and consideration of gender differences in development of rehabilitation programs. Pain acceptance might be important to take in consideration and be targeted in treatment. More clinical research is needed to increase awareness on how these aspects may impact in the rehabilitation of chronic pain.

3. Psychometric Properties of the Meaning in Life Questionnaire as a Measure of Values in Patients with Chronic Pain
Primary Topic: Beh. med.
Subtopic: Chronic Pain
Whitney Scott, B.A., McGill University
Elena Bernier, McGill University
Michael Sullivan, Ph.D., McGill University

Research in the field of chronic pain has shown that values-based action is associated with less chronic pain-related distress. However, the assessment of values in chronic pain remains preliminary. For instance, current measures only assess a limited subset of valued domains, and not patients’ more global sense of life purpose. Recent work using the Meaning in Life Questionnaire (MLQ) suggests that both the presence of and search for meaning in life uniquely predict distress in patients with chronic illness. The study describes the psychometric properties of the MLQ in patients with chronic pain. One hundred and seventy-three individuals with chronic pain completed the MLQ and self-report measures of pain intensity, acceptance, and depression. Results indicate that the MLQ has adequate internal consistency, and a two factor structure, reflecting the presence of and search for meaning. Nonsignificant correlations of the MLQ with pain intensity, and significant correlations with acceptance support discriminant and convergent validity, respectively. Hierarchical regression analyses suggested that both the presence of and search for meaning uniquely predict depressive symptoms. Consideration of the distinctiveness of the presence of and search for meaning in life may enhance the current understanding of values among patients with chronic pain.

The present study examined the efficacy of a mindfulness and acceptance-based intervention for anxiety, and whether the program would have the additional positive outcomes of improving mindfulness, distress tolerance, and adaptive coping. A quasi-experimental open clinical trial utilising a Mindfulness and Acceptance and Commitment Therapy intervention (Forsyth and Eifert, 2007) was undertaken with university students (predominantly female) who reported moderate to high levels of anxiety. Efficacy analysis via repeated-measures between-groups ANOVA indicated overall that the intervention was efficacious for those who completed the program; when compared to a wait control group. Statistically significant improvements in trait anxiety; disruption to work, school, family and social life; mindfulness and mindfulness skills; ability to take action in valued directions; emotional distress tolerance; and avoidant coping; were all found, and maintained over time. Clinically significant reductions in trait anxiety were also found in almost a third of training completers. It was also concluded that the intervention is theoretically potentially efficacious for those individuals who are seeking a more adaptive way of coping, than utilizing non-suicidal self-injury (NSSI) to escape or avoid overwhelming aversive internal arousal.

This study examined pre-post treatment changes in a pilot sample (n =6) of clients with psychotic disorders receiving 16 sessions of Acceptance and Commitment Therapy (ACT) in an outpatient community mental health clinic. Trained clinical psychology graduate students who provided the treatment were rated for adherence to the study treatment protocol. Participants reported clinically significant decreases in distress associated with hallucinations and delusions as measured by the Psychotic Symptom Rating Scale (PSYRATS) and clinically and statistically significant increases in quality of life as measured by the World Health Organization Quality of Life Questionnaire- Brief Version (WHO-QoL-BREF). Study participants demonstrated clinically and statistically significant decreases in psychological distress as measured by the Outcomes Questionnaire-45. There was a relatively low rate of drop-out for this population indicating that participants found the treatment acceptable. These results suggest that ACT can be delivered effectively in a time-limited format by trained graduate student therapists.

Mindfulness-Based Therapy (MBT) has become a popular intervention for a variety of affective problems, including stress, anxiety, and depression. However, the existing reviews report inconsistent findings. In order to clarify the inconsistency in the literature, we conducted an effect size analysis to evaluate the efficacy of MBT. A systematic review of studies (n = 7611) published in journals or in dissertations in PubMED or PsycINFO from the first available date until April 3rd, 2011, was conducted. A total of 138 studies met our inclusion criteria. The effect size estimates suggested that MBT is moderately effective in pre-post comparisons (n = 52; Hedge’s g = .58), in comparison with waitlist controls (n = 45; Hedge’s g = .53; 95%), and when compared with other active treatments (n = 41; Hedge’s g = .31), including other psychological treatments (n = 22; Hedge’s g = .17). These effect sizes were robust, and were maintained at follow-up. Mean effect size of clinical outcomes was strongly positively related to the mindfulness level of participants and moderately positively related to the clinical training of therapists. We can therefore conclude that MBT is an effective intervention for psychological problems.

We conducted a meta-analysis to investigate the effectiveness of cognitive behavior therapy third wave strategies for psychosis and schizophrenia, namely: compassion, acceptance, detachment, and mindfulness. We included eight studies that met the selection criteria enrolling a total of 263 participants. Effect size estimates suggested third wave strategies were moderately effective in within-group pre-post analyses (Hedge’s g = .59). When compared with a control group, we found smaller effect sizes (Hedge’s g = .37). The obtained results were maintained at follow-up when data was available. Results suggested higher effects on negative symptoms compared with positive ones. Mean effect size of clinical outcomes was slightly negatively correlated with the quality score of the studies. Mindfulness was not found to moderate the mean effect size of clinical outcomes.

Emerging evidence suggests the usefulness of CBT protocols that incorporate third wave strategies (3rdW) of cognitive behavior therapy such as ACT or mindfulness therapies for people with psychotic disorders. This pilot study aimed at applying 3rdW strategies, namely, compassion, acceptance and mindfulness in a comprehensive 8-week long group treatment for early psychosis. This pilot study examined the compassion acceptance mindfulness based treatment (CAMT) with 3 groups for a total of 12 participants with psychosis spectrum disorders at three time points (pre-treatment, post-treatment and 3-month follow-up). Findings indicate that the intervention was feasible and associated with increased emotional self-regulation, decreased symptoms, especially anxiety, depression, and somatic concerns, and improvements in self-care. Results are promising; controlled research is warranted to validate the effectiveness of the new treatment.

Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999) is a mindfulness, acceptance, and values-based psychotherapy which proposes different processes of change and outcome compared to traditional cognitive and behavioural treatments (Hayes, Masuda, & De Mey, 2003). While the research on the effectiveness of ACT for treating a number of psychological problems has yielded some preliminary support, more work needs to be done to clarify its place among more traditional, empirically-supported interventions. In this study we evaluated the impact of participation in an ACT trans-diagnostic group program being conducted in a private hospital setting in Metropolitan Melbourne, Victoria. In addition to the primary aim of treatment evaluation, this research was also aimed at exploring whether ACT is associated with decreased rumination and worry in individuals with depression and anxiety, given the significant role these cognitive processes play in the onset and maintenance of anxiety and depressive disorders (Hoeksema, Wisco, & Lyubomirsky, 2008; Watkins, 2008). In order to evaluate effectiveness of the program in a rigorous manner, both outcome and process measures were utilised. Participants were assessed on all outcome measures at four time points: prior to receiving the intervention, post-intervention, at one month follow-up, and at six month follow-up. Process evaluation included assessment of treatment fidelity, client completion of program components, and client satisfaction with the program. Preliminary results of this study are pending. Strengths, limitations, implication for practice and future research will be discussed.

Background: Health anxiety (HA), or hypochondriasis, is characterized by a preoccupation with fear of having a serious illness, which interferes with daily functions and persists despite medical reassurance. Aim: To develop an internet-delivered Acceptance and Commitment Therapy (I-ACT) program for HA, based on an existing ACT-group manual, and to preliminarily test its efficacy. Methods: A pilot study of 40 patients with severe HA who will receive 9 sessions of I-ACT. During treatment, email support will be provided. Self-report questionnaires will be obtained before treatment and at the end of treatment, measuring illness worry (Whiteley-7) as primary outcome. Results: The preliminary results and experiences will be used in the planning of a larger RCT of I-ACT for HA. Perspective: I-ACT for HA may be a feasible and flexible treatment form, which can be delivered to a broader patient population, e.g., younger patients or patients with less severe symptoms.

The present study focuses on analyzing the effects of two protocols to alter the function of private events (as thoughts, feelings, memories, and rules related to them). Two defusion protocols were compared to a control one in regard to participants' thoughts that were organized in three blocks for each participant. Each protocol was implemented successively to a block of thoughts in a pre-post design with follow up. One protocol was designed based on deliterization while the other is based on perspective/hierarchical framing. Several questionnaires (AAQ-II, KIMS-R and CFQ) and a specific experimental task were used in pre and post test. In addition, the impact of the protocols, as chosen by each participant after post-test, were measured in regard to problematic areas according to the participants' information at pre-test. All phases were implemented to participants without, and with, clinical criteria. Results were analyzed across individuals as well as considering both types of participants.

In 2012, Western Health’s Drug Health Services (Melbourne, Victoria), identified an opportunity to deliver ACT/ mindfulness skills to clients in a community residential withdrawal setting. Two staff, trained in Acceptance Commitment Therapy established a program delivered in a one hour, single session. Participants of the ACT residential withdrawal program are provided with a range of practical skills that they can implement into their everyday lives. Components include: breathing techniques, exploration of values and importance of setting value based goals, discussion regarding contact with the present moment as opposed to experiential avoidance through alcohol or other drugs. The concepts of fusion and defusion are introduced. The group has been running weekly for over 12 months and feedback questionnaires demonstrate that 80% of participants intend to use these skills in their daily lives.

Despite weight-loss being achievable, weight-loss maintenance (WLM) remains elusive. Significant yet limited research suggests there is a relationship between (WLM) and emotional eating (EE). Functionally EE reduces negative affect and can be conceptualised as a form of experiential avoidance (EA). EA is a key process within the ACT model. Emerging evidence indicates that ACT interventions can assist in WLM, and show that EA accounts for significant variance while cognitive fusion (CF) is speculated to. A RCT was conducted using a 1-day ACT intervention targeting EE for WLM. Participants (n=99) had recently lost weight and were ≥ the BMI normal weight range. Participants were randomly assigned to the active or control group. The key ACT process measures employed were: AAQ-II; AAQ-W; CFQ. Data were collected at baseline and 3 months. Preliminary analyses show significant results. This is the first RCT to measure EA and CF together with EE within the context of WLM.

Since Acceptance and Commitment Therapy (ACT) does not focus on symptom reduction, there is also a need for a different type of assessment measure. Though there are a number of ACT-questionnaires available, some ACT-components can’t be structurally assessed yet. The researchers wanted to develop an ACT-questionnaire that could assess all six ACT-components, as well as the overall psychological flexibility. The result of this study is the realization of the Flexibility Index Test (FIT-60); a self-report questionnaire which rates on all six components and psychological flexibility (scores can also be visually presented in a flexibility-profile). The initial psychometric qualities of the FIT-60 are encouraging; the internal consistency is good (α = .69 - .95), the construct validity is acceptable (r = .39 - .91). The FIT-60 is still undergoing extensive additional validation. This questionnaire was originally developed and validated in Dutch; an official English translation is also available.

The purpose of the current study was to examine whether applying a package composed of rationale, training, and experiential exercise to the Soldiers in the Parade Exercise (Hayes, Strosahl et al., 1999, pp. 158–161) will be effective and what effect a choice of exercises will have. This study assessed the tolerance time, the subjective pain and distress intensity in three groups (choice group, no-choice group, and control group) when the participants underwent a cold pressor task. Results showed that applying the above package to the Soldiers in the Parade Exercise is effective in increasing the tolerance time. However, the hypothesis that a choice of exercises would increase the effects of exercises wasn’t supported. Furthermore, the comparison between varieties of exercise showed that the effects of exercises differed according to images used in exercises.

The purpose of the present study was to investigate the effects of Acceptance and Commitment Therapy (ACT) on the depression and distress experienced by parents of children with developmental disability. A waiting list control design was used, in which the parents were assigned either to an ACT workshop group (n=9) or a waiting list control group (n=11); the latter group was given identical ACT workshop after the first group had been trained. ACT workshop was conducted for two days (six hours in a day). Parents were assessed two weeks before the workshop (phase1), one week after (phase2), and six weeks after (phase3): Beck Depression Inventory-Ⅱ(BDI-Ⅱ), General Health Questionnaire-28(GHQ-28), Five Facets Mindfulness Questionnaire(FFMQ), Acceptance and Action Questionnaire II (AAQ-II), Japanese Irrational Belief Test-Revised (JIBT-R). While in phase1 and phase2, no significant change occurred in the waiting list control group, but the ACT workshop group improved on the BDI-Ⅱ. Process measure of mindfulness also changed. From pre to follow up, statistically no significant improvement was found for both outcome and process measures.

Community Health workers identified a need for a new way of assisting their many clients who had various chronic physical conditions ranging from diabetes to cardiac conditions and more. Medical, educational and rehabilitation interventions were sometimes not enough to aid these people, who might also have depression, anxiety and /or social isolation. A weekly group program was developed based on Acceptance and Commitment Therapy (ACT). The More to Life group was open to people with various physical conditions; not targeted to just one condition, such as diabetes. In the worldwide literature there did not appear to be an ACT protocol for this type of generic group intervention. Elements of action research were used to establish and trial the program, gain feedback, modify it slightly and run it five times over two and a half years. Participants’ pre and post intervention self-rated measures indicated that their social dysfunction, depression and anxiety all decreased and their psychological flexibility increased.

The purpose of this presentation was to show the ACT practice for the mother of a child having Asperger syndrome disordered (ASD), and to examine the effectiveness of parental supports at the view point of ACT. The participant was a mother, Yoko, having a child with ASD. Her husband (John) was not eager to learn the parental skills which were necessary for parenting an ASD child. Therefore, he often had troubles with his son. Yoko taught John how to treat him repeatedly. However he always listened to her in silence; John’s behaviors did not change. Yoko gave up teaching him and took care of her son almost all day long. Yoko became depressed and took medicines. A four-hour ACT session was introduced to her. The six competencies of psychological inflexibility were assessed, and defusion exercises, and the value works to identify parental value were introduced in the session. Three- month follow-up investigation revealed that the GHQ-28 (General Health Questionnaire-28) decreased six points, BDI-II (Beck Depression Inventory-II) decreased eight points. AAQ-II(Acceptance and Action Questionnaire-II) increased four points at the follow-up. The irrational beliefs which were measured by JIBT-R (Japanese Irrational Belief Test-Revised) were not changed. Considering these results, ACT worked for the improvement of parental mental health problems.

Emotional awareness is the ability to identify, label and describe one’s emotions, and is a key target of ACT interventions which seek to increase experiential acceptance and contact with the present moment. Even though emotional awareness is assumed to be essential for establishing supportive personal relationships, there has been limited longitudinal research assessing the extent that awareness is an antecedent to the development of social support. The present study investigated the relationship between the development of emotion awareness and social support over a three year period (Grades 9-12) in adolescence. Students from five Australian high schools completed yearly self-report measures of emotional awareness and the quantity and quality of social support. Cross-lagged structural equation modeling was used to assess the extent to which emotional awareness is an antecedent to changes in social support, a consequence of changes in social support or, both representing a reciprocal influence model. We found evidence for the reciprocal influence model, indicating that awareness led to higher quality social support and higher quality support led to greater awareness.

This quasi-randomized controlled trial compared the effect of two components of cognitive and behavioral therapy. Delivered as brief interventions to groups of test-anxious university students (n = 78), each component was predicted to change cognitive responses to worrying exam-related thoughts. Both interventions - cognitive defusion and cognitive restructuring - were associated with improved exam performance whereas the control was not. Sixty-four percent of students who participated in an intervention attained meaningful improvement in their exam marks compared to 29% in the control condition. Results indicated the cognitive defusion was more effective for exam mark improvement than cognitive restructuring. There were intervention-specific changes in the frequency of defusion responses to bothersome exam-related thoughts but not restructuring responses. After the interventions, the frequency of students reporting cognitively distorted bothersome exam-related thoughts reduced in the restructuring intervention group but not in the cognitive defusion group. Results are discussed in terms of the benefits of brief interventions for test anxious students, and effective components of psychological treatment. Recommendations for further research are proposed.

Deficiency in academic skills is one of the most common risk factors that contribute to university drop-out and procrastination of exams. Thus one of the main goals of a University Counseling Service is to help students face difficulties in their academic career. A group of university students who asked for help volunteered to participate in our study. Students were randomized in two treatment conditions based on 4-session courses. One course was conducted following a traditional instructional program that included providing information about the functioning of cognitive processes involved in studying and the most efficient methods to adopt (e.g. time management skills, learning and memory techniques etc.). The other course was the same as the first one but potentiated with an experiential ACT-based intervention. Self-report measures about academic behavior, mindfulness (MAAS), experiential avoidance (AAQII), values (VLQ), anxiety and psychological suffering (PSWQ SCL90, STAI-Y) were collected before and after the training. Preliminary results on the efficacy of the trainings will be reported.

This study examines the impact of psychological flexibility on emergent leadership behavior in self-managed teams. We hypothesize that psychological flexibility enhances team member performance and satisfaction by allowing individuals to notice, comprehend, and respond effectively to leadership opportunities in the team context. We used Structural Equation Modeling of 395 participants in 76 self-managed teams to test our hypotheses. Consistent with predictions, results show that individuals’ psychological flexibility had a positive impact on emergent leadership behavior, which in turn influenced their peer-rated performance and satisfaction with the team experience. The findings provide initial evidence that psychological flexibility in team members can improve performance in self-managed teams.

While some studies have shown the result that acceptance-based coping strategy increases pain tolerance and control-based coping strategy decreases it, the effect upon subjective pain has shown variability. Luciano, Gutierrez-Martines, Barnes-Holmes, Valdivia, Cabello, Barnes-Holmes, Rodriguez Valverde, & Wilson(2010) examined the effects of two protocols upon the level of discomfort instead of subjective pain. But the research’s design had some problems because of its complication. Therefore this study employed a simpler design. There were three groups of protocols about coping with discomfort. The ACT group received an instruction based on acceptance, and the EA group received an instruction based on experiential avoidance. The control group received no indication about coping. Forty five participants tried former five 3-min multiplication and division tasks and later ones, listening to a loud noise through headphones. The level of discomfort induced by the noise was measured after each task finished. Each protocol (ACT, EA, control) was given between pretests and posttests. This study aimed to analyze the difference of discomfort and task score (the number of correct answers) between the protocols or between pretests and posttests. The ACT group and the control group showed less discomfort at the posttests than the pretests, while the EA group showed more discomfort. At the posttest, the ACT group and the control group resulted in less discomfort than the EA group, and there is no difference between the ACT group and the control group. Task score of posttests decreased in the EA group, increased in the control group, and was similar in the ACT group compared to that of pretests. Since this study used a single noise through the ten tasks (30 minutes total), it was possible that participants accommodated to the noise.

The present study focuses on the interactions involved in processes of Defusion exercises that ensure its efficacy reflected in an improved performance on cognitive tasks. For that, in the first phase, 20 participants performed two cognitive tasks in the presence of visual and auditory distracters. In the second phase, the participants received a protocol based on the condition to which they were randomly assigned. Participants of the Defusion Condition I performed exercises in order to acquire flexibility and fluency in deictic and hierarchical framing their private events to strengthen the self as context. Participants of the Defusion Condition II performed the same exercises but only through deictic framing. Finally, in the third phase, both groups performed the two cognitive tasks again. Among the results, the improvement in the performance of the tasks is evaluated and the two different Defusion methods are compared.

Relational frame theory (RFT) suggests that the comparative relational framing included in the self-rule enables us self-control. The purpose of the current study is to identify whether the Self-Control is related to the transformation of stimulus function in accordance with the comparative relating. Nine undergraduate students participated in this study. They were exposed to a more than / less than relational task, which involved the tests of the derived relations and the transformation of stimulus function. After relational task, they completed the delay discounting questionnaire, investigated self-control choice. Participants who passed the test showed lower discounting rate than participants who failed the test. Results revealed that the participants who passed the test preferred self-control choice in the delay discounting questionnaire. We discussed the role of the comparative relational framing in the self-control from the perspective of RFT.

26. Bachelor Thesis at University College of Molde, Norway, 2012: ACT(Acceptance and Commitment Therapy): Is this mindfulness-based cognitive intervention an alternative to medical treatment of anxiety disorders?
Primary Topic: Theory & Philo.
Subtopic: Anxiety Disorders, ACT vs Medical Treatment, Quality of Life
Randi Brevik, College University of Molde, Norway

After a few years in the mental health sector, I have seen how anxiety disorders have been a consistent feature. I have followed the debate on the pharmacological treatment of anxiety disorders in relation to psychodynamic and applied behavior analytic approaches. There has been some coverage in recent years in the media about the border and unreasonable number of prescriptions. I have observed disagreements between professionals about who has the right way to approach both psychological and somatic problems. I reflect on the pathological attitudes of health care as in the treatment of certain diagnoses, and medicalization of suffering. I was introduced to ACT in my work in mental health care. My curiosity was piqued; I attended workshops, read all the literature I came over and practiced the method on both myself and my clients. I have thoughts about how the drugs can lead to a problematic addiction and how side effects can occur creates more problems than anxiety, and how medicine can prevent effective yield of the therapeutic treatment. I have thoughts as a professional practitioner to date on recent theories and methods that are relevant for the social education profession. The purpose of the choice of theme: providing insight and create interest for this method can be a supplement for targeted therapy, creating a consciousness change about being involved and decide on their own lives. Social educator works on the basis of a humanistic and holistic perspective, the idea that all we have the resources and the key to the solution of our problems and to actively participate in finding solutions. Anxiety disorders seem to have a common goal: avoidance of experience. Drug therapy has a function, but there is a risk of addiction and worsening of symptoms. I have referred to the ACT's philosophical perspective and its practical application in the treatment of anxiety disorders. Perspectives on how to deal with anxiety disorders are many, and it can be as many solutions. Is it ultimately the achievement of quality of life, something that both methods have in common? The analyzes I have referred to show that the average ACT as method is effective in reducing symptoms and in increasing psychological flexibility and greater quality of life. Everywhere I interpret these studies as positive ACT method and that it has a relatively high degree of efficiency in the applied treatment of anxiety disorders. ACT method is autonomy - and value-based. Whether the ACT is an alternative to drug therapy I believe will finally depend on client preference for treatment, and not least depend on the ideology that prevails at the treatment site. From a holistic and humanistic perspective and our own experiences in mental health, I am of the opinion that the ACT is a very good alternative to drug therapy. The reason lies in the idea that the challenges of anxiety are highlighted and one has the possibility to decide then and there, act with open eyes. Medication can dull the senses and in my opinion, prevent the anxiety sufferer to see the possibilities.

This study examined whether the response sequences generated by the students with high cognitive fusion are more rigid compared to those of the students with low cognitive fusion. The study also investigated whether providing the direct reinforcement can increase the sequence variability in the participants with high cognitive fusion. Sixty-three students were divided into two groups; the high cognitive fusion group and low cognitive fusion group depending on the score of the Japanese version of Cognitive Fusion Questionnaire-28 (J-CFQ-28). All students participated in a computer-game consisting of two phases. The response-sequence variability during the computer-game was recorded. When reinforcement was provided independently of the sequence variability, the participants in the high cognitive fusion group showed the same level of variability in their responding compared to the low cognitive fusion group. When high sequence variability was required in order to receive the positive feedback, the variability significantly increased in all participants.

As the first study of the current study, 34 defusion exercises were classified based on function of exercises to make a plan to examine mechanism for defusion effect. As the result, it was the hypothesis that defusion consists of three components. 43 participants were assigned to one of three groups; forward-sequence group (FG), backward-sequence group (BG) and control group(CG). FG did three exercises through the order based on the hypothesis: 1.Carrying cards exercise, 2.Labeling your thoughts exercise, and 3.The mind exercise. However, BG did exercises through the reverse order of FG. CG did not do exercises. The current study showed FG decreased fusion for aversive thoughts and increased mindfulness, but BG decreased discomfort because of avoiding aversive thoughts. These results indicated that it is necessary that decreasing aversion for thoughts and increasing awareness for thoughts and feelings is the process before weakening the rule about locus of control.

Shame stems from the dysphoric emotions that involve negative evaluations and conceptualization of one’s own self (Niedenthal, Price, Tangney, & Gavanski, 1994), and is defined as an intense emotion associated with serious failures and moral transgressions (Dalgleish & Power, 1999). Students often experience the self-conscious emotion shame in academia when their thoughts begin to focus on the negative aspects of themselves in an academic environment. In this study, we ask the question whether a meditation that is based on relational frame theory principles can improve the experience of academic evaluations among American college students. 100 participants are recruited for this study. The participants are randomly assigned to 2 conditions: the meditation group will be exposed to a meditation exercise that aims to distance the participants from their own negative self-conceptions. The control intervention group will also receive a sensory stimulus that is similar in its physical characteristics but differs significantly in its meaning and content. The two groups will also be exposed to an intellectual performance task and will be asked about their experiences during this task. We will see if the ACT intervention group shows better results at the intellectual performance task and has a better experience than the control intervention group, thus demonstrating the beneficial effects of targeting detachment from negative and inhibiting self-judgments through a meditation exercise. Potential implications for refinement of mindfulness exercises in college programs will be discussed.

Asthma is a chronic inflammatory disease of the airways, resulting in airflow obstruction. Research emphasizes the influence of individual differences on the quality of life (QOL) of asthma patients. The aim of our study was to explore how gender impacts QOL, whilst measuring the role of three levels of anxiety: non-clinical, sub-clinical, and clinical. The extent to which experiential avoidance moderates this association was also investigated. Two hundred and four asthma patients (136 women) from the Nicosia General Hospital completed a packet of questionnaires including the AQLQ, the PHQ, and the AAQ-II. Results showed that women with asthma report poorer asthma-specific QOL compared to asthmatic men. Women in all three anxiety levels reported lower QOL on three of the four subscales. These results may aid in the design of personalized health care programs which take into account both the psychological factors associated with and gender of asthmatic patients.

Rehabilitation following anterior cruciate ligament (ACL) surgery can be challenging. Mood disturbance and alcohol misuse are possible adverse outcomes during the rehabilitation phase. Predictors of mood disturbance and maladaptive behaviour may assist practitioners to identify athletes who may have difficulties during rehabilitation. Pain catastrophizing has been associated with affective disturbance and pain intensity following surgical repair of the ACL. Acceptance from a contextual behavioural perspective is an important concept in adjustment to chronic pain; it is negatively correlated with depression and disability. However, no previous studies have investigated the role of acceptance in the early stages of rehabilitation post ACL repair. The aim of this study was to compare the role of pain catastrophising and acceptance as predictors of depression, pain intensity and alcohol misuse. Individuals who had undergone ACL surgery completed the assessment within 4 weeks of ACL surgery (N = 44) and again at 4-6 months post surgery (N =26). Predictor measures were the Pain Catastrophizing Scale and the Acceptance Action Question. Outcome measures included the depression scale of the Depression Anxiety and Stress Scale, numerical rating scale of pain intensity, and the alcohol misuse subscale of the COPE. In accordance with previous research, pain catastrophizing was associated with pain intensity and affective disturbance in the early post-operative phase. By contrast, acceptance in the early post-operative phase was predictive of depression at 4-6 months, even after controlling for early post-operative depression. Acceptance was also negatively correlated with the use of alcohol as a way of disengaging from the stress of being injured. Implications for sport injury rehabilitation and future research are discussed.

This study discusses the effect of bodyscans, a type of mindfulness training, on the students who participated in this investigation. To explore the effect of bodyscans, I used two types of indices. One is an index measuring the bodyscan’s immediate effect, while the other measures the effects of practicing it repeatedly over two weeks. First, to measure the trait of mindfulness in study 2, study 1 assessed the test-retest reliability of the FFMQ (Five Facet Mindfulness Questionnaire). Among 44 students, one of the coefficients of the test-retest reliability consisted of stability, excluding the factor of nonjudging of inner experience. Study 2 assessed the bodyscan’s immediate effects and the effects due to practicing it repeatedly. In the immediate effects, a decrease of positive, depressive, and anxious moods was observed. In the effects due to repeated practice, participants who achieved better handling of this type of private event, such as regarding their thinking or feeling, increased their psychological flexibility and decreased their worry.

Creative Hopelessness serves as a motivative augmental for the fundamental change (Hayes et al., 1999). The present study examined the motivative effects of the augmental acquired by CH on the social avoidance tendency and valued actions. Participants with social avoidance tendency were randomly assigned to either the experimental group or control group. The experiment consisted of two experimental days. On the first day, participants were asked to complete the pretest assessment and CH intervention. Following the intervention, the newly acquired augmentals were identified. Between the two experimental days, only the experimental group was asked to recall the augmental for two weeks in their daily life. On the second day, participants completed the posttest assessment. The result revealed that improvement in social avoidance tendency was found only for the experimental group. Also, the experimental group showed greater valued actions compared to the control group. These results might support that CH serves as a motivative Augmental.

5. The Impact of Cognitive Reappraisal on Well-Being is Sensitive to Context: The Role of Satisfying Relationships
Primary Topic: Clin. Interven. & Interests
Subtopic: Emotion Regulation
Robert Brockman, M.A. (Clin Psych), University of Western Sydney (UWS)
Joseph Ciarrochi, Ph.D., University of Western Sydney (UWS)
Todd Kashdan, Ph.D., George Mason University (GMU)
Rebecca Pinkus, Ph.D., University of Western Sydney (UWS)

It is becoming increasingly clear that the relationship between specific emotion regulation strategies and well-being may be substantially influenced by contextual factors, including individual and social-environmental factors (Butler & Gross, 2009; Rimé, 2009). Recent advances in the methodology of empirical studies such as ecological momentary assessment (EMA), daily diary studies, and multi-level modelling designs are well placed to investigate the role of context on the impact of various emotion regulation strategies on well-being (Nezlek, 2007). The current study implemented an EMA design with 287 university students, collecting daily measures over the course of 21 days. This study investigated the distinctive link between well-being and three emotion regulation strategies, namely, emotion suppression, cognitive reappraisal, and mindfulness. Multi-level modelling found evidence of substantial within-person variability in the link between each strategy and well-being. Consistent with the assertions of 3rd wave behaviour therapy traditions (e.g. Acceptance and Commitment Therapy, Mindfulness-Based Cognitive Therapy), daily mindfulness was found to be a significant predictor of daily well-being, whilst emotion suppression was found to be a significant predictor of reductions in well-being amongst the total sample. The relationship between reappraisal and well-being was found to be somewhat more complicated. In the current sample, daily reappraisal was associated with both increases and decreases in well being depending on the person, revealing the contextual nature of the relationship between reappraisal and well-being in daily life. To further investigate the contextual nature of re-appraisal, the current study tested a moderation model for relationship need satisfaction, finding evidence that the impact of daily re-appraisal on well-being is significantly moderated by the degree to which their relationship needs are currently being met. Implications for the emotion regulation literature and the interface between 2nd and 3rd wave therapy approaches are discussed.

While 1-2% of the general population meets the criteria for Borderline Personality Disorder (BPD) up to 65% of substance users in treatment meet criteria for BPD. Clients with co-occurring Substance Use Disorder (SUD) and BPD have greater levels of psychosocial impairment, psychopathology, substance use, unsafe injecting, self-harm and suicidal behaviour. Treatment studies highlight that these clients have higher rates of relapse, treatment noncompliance and poorer outcomes than those with either diagnosis alone, while SUD significantly reduces the likelihood of clinical remission of BPD. There is some evidence in the literature for the effectiveness of ACT-based treatment approaches in AOD settings, particularly in relation to reducing opiate use, nicotine dependence, and methamphetamine use. Making Waves aimed to test the feasibility and effectiveness of implementing a 12-session ACT intervention (Wise Choices) within an AOD service for the treatment of clients with SUD and borderline features. Both client and clinician outcomes were explored. Technology transfer took the form of two training workshops in addition to fortnightly coaching in ACT for an 18 month period. The coaching comprised client-based clinical review and role plays of ACT techniques in a group supervision model. Client outcomes included a reduction in BPD symptoms; reduced alcohol and drug use; improved quality of life; and improved ACT-related skills, in particular, emotion regulation and acceptance and values based action. Clinician outcomes included increased confidence in implementing ACT and increased likelihood that they will continue to use ACT and recommend this treatment approach to colleagues compared to baseline. Qualitative results indicated that clinicians found ACT useful with clients with complex presentations and the ACT techniques were a ‘good fit’ for the AOD setting. In conclusion, unlike DBT, ACT is a feasible intervention for AOD services to implement for clients with complex psychosocial needs. Implementation fidelity for the Wise Choices ACT treatment was maximised when methods informed by the evidence for technology transfer were applied.

The aim of this poster is to introduce, describe and make potential collaborators from the experts to the “ALGEA” project, an innovative bio-psychosocial intervention programme for the treatment of chronic pain, funded by the EU Cross-border Cooperation Programme “Greece-Cyprus 2007-2013”. ALGEA (the Greek word for suffering) aims to (a) enhance our understanding of chronic pain, as well as of the needs of chronic pain patients and their families, in order to (b) design and implement an innovative treatment program for these patients and their families. The intervention programme will employ an Acceptance and Commitment Therapy (ACT) perspective and will use cutting-edge technology to develop customized e-treatment modules (like Apple or android applications). It will also incorporate an interdisciplinary approach combining psychological intervention and medical therapy as the treatment of choice. The ALGEA project is implemented by the Department of Psychology and the ACTHEALTHY lab settled at the University of Cyprus, the Department of Psychology, University of Crete and the Cyprus Institute of Neurology & Genetics. The project purposes are to: a) develop and evaluate a toolkit assessment of chronic pain and its impact, b) create a therapeutic manual-protocols group psychosocial intervention for chronic pain to be used by mental health professionals, c) personalize an online treatment program for chronic pain (web-based intervention, android applications), d) train human resources in health and chronic pain units using the e-platform therapeutic modality, and e) create the institutional integration of the program to public and non-governmental medical and psychosocial services. Adopting the principles of the European Commission (The Steering Committee of the Pain Proposal initiative ), the World Health Organization for chronic pain and the ABCT suggestions, "Algae program" aims to create an innovative environment for the management of chronic pain both in Greece and Cyprus initially and later in the pain-related therapeutic environment, which will offer support to the patient suffering from any type of chronic pain and their families, the physicians in their effort to reduce pain, and it will contribute to the creation of a new culture aimed at individualized intervention and improved quality of life.

The current study combines ACT and general group therapy theory and research to identify predictors of recovery in patients receiving naturalistic multi-modal psychiatric treatment in a private inpatient setting. Psychological flexibility and the group processes of self-disclosure and expression of painful affect were identified as variables of interest. Participants consisted of ninety-seven inpatients with a DSM-IV TR diagnosis of mood disorder. Pre- and post-treatment scores were obtained for psychological flexibility and depression while ratings of levels of self-disclosure and expression of painful affect were provided by psychologists conducting group ACT sessions. Results indicated a large overall treatment effect as measured by reductions in symptoms of depression from beginning to end of treatment. Improvements in psychological flexibility best predicted recovery from depression; accounting for more than a quarter of the variance in recovery from depression. Recovery was also predicted by changes in self-disclosure but not expression of painful affect. Interestingly, initial high levels of self-disclosure, followed by a reduction over the course of treatment produced better outcomes. The findings add to the current literature by (1) highlighting the importance of psychological flexibility as a predictor of change , and (2) exploring the relative importance of key variables identified in group therapy research.

The ACT for Recovery project will conduct the first randomised controlled evaluation of ACT for psychosis (ACTp) workshops for service users and caregivers in community psychosis services in the London Borough of Lambeth. We will also assess the feasibility of training service user co-facilitators to deliver the ACTp workshops. This poster presentation will discuss the qualitative experiences of service user co-facilitators of being trained to deliver ACTp workshops and also the experiences of client and caregiver participants attending the workshops. Preliminary data on the role of disclosure from service user co-facilitators on processes such as stigmatisation, perspective taking and defusion will be explored. Preliminary qualitative and quantitative data will also be presented.

There has recently been a growing interest in spirituality and its role in a number of psychological problems. Having a religious affiliation appears to be related to lower overall anxiety, and intrinsic religiosity is associated with less worry (Shreve-Neiger & Edelstein, 2004). The psychological mechanisms of the relationship between religiosity and anxiety, however, are not well understood. Experiential avoidance (EA) is also implicated in the development and maintenance of anxiety disorders (Kashdan. Morina, & Priebe, 2009). While mindfulness interventions have begun to view the task of reducing experiential avoidance as a spiritual effort, the relationship between experiential avoidance and spirituality in an anxious population is still not clear. The present study will investigate whether spirituality moderates the relationship between experiential avoidance and social anxiety in participants with symptoms of social anxiety (N = 120). Results from this study will give us a greater context in understanding the relationship of spirituality and its effects in socially anxious individuals.

11. The effects of self-compassion between depression and suicidal ideation
Primary Topic: Clin. Interven. & Interests
Subtopic: Self-Compassion, Depression, Suicidal Ideation, College Students
Sun-mi Yang, Ph.D. Candidate, Seoul Women's University Graduate School of Professional Therapeutic Technology in Korea
Kyung Park, Ph.D., Seoul Women's University Graduate School of Professional Therapeutic Technology in Korea

This study examined the effects of self-compassion on depression and suicidal ideation. The participants were 350 college students of both gender(193 males, 157 females) who agreed to take part in this study completed a self-report version of scale. The research tools used on them were Beck Depression Inventory, Self-Compassion Scale(Self-Kindness, Self-Judgment, Common Humanity, Isolation, Mindfulness, and Over-identified), and Scale for Suicidal Ideation(Ambivalence of Suicide, Active Suicide ideation). The result was that self-compassion had negative relationships on depression and suicidal ideation. Self-Kindness, Self-Judgment, Common Humanity and Isolation of sub-factors of self-compassion showed negative relationships on depression and suicidal ideation. Over-identified had positive relationships on depression and suicidal ideation. However, Mindfulness showed negative relationships on only depression. Self-compassion evaluation showed to be a factor to moderate depression between suicidal ideation. These results identified the importance of improving self-compassion on depression promotion that affected the suicidal ideation. ACT in psychological intervention for depression may lead to an increase of suicidal ideation and limitations of this study were discussed.

Although depression was studied for a long time, it is still recognized as a public health problem in Korean society. Especially, depression affects females more than males. The present study examined the effectiveness of group intervention based on Acceptance Commitment Therapy for women’s depression. Sixteen Korean young adult females with depression participated in ACT which consisted of 10 weekly 120 min sessions. Other Fifteen females were assigned waiting list control. All participants(age range 19-37 years) completed a self report questionnaire which is comprised of Beck’s depression inventory, Acceptance action questionnaire, Automatic thoughts questionnaire-negative type, Self compassion scale, and Mindfulness attention awareness scale at pretreatment, middle term, and posttreatment. Also outcome variable(depression) and process variables(acceptance, automatic negative thought, self compassion, and mindfulness) were assessed at follow up in the ACT group. The ACT group not only showed remarkable reduction of depression, but also process variables(acceptance, automatic negative thought, self compassion, and mindfulness) significantly changed at time of entry. Further, changes of them still maintained to follow up as after a 2 months lapse. Particularly, mediational analysis verified that change of acceptance and automatic negative thought mediated the effect of intervention on depression at follow up. The results of this study suggest that the group intervention based on ACT is effective for reduction of women’s depression in Korea.

The purpose of the present study was to examine the effects of Cognitive Defusion on negative automatic thought and anxiety response of speech anxiety. The Cognitive Defusion, one the key processes of acceptance and commitment therapy, is to prevent suffering from one's thought and aims to make people aware that a thought is just a thought and a feeling is just a feeling. The negative automatic thought in speech-anxious people can be explained as cognitive fusion. They believe their negative thought as vivid truth and it makes them more anxious. The hypotheses for this study were Cognitive Defusion would be more efficient in decreasing negative automatic thought believability, belief in feared consequence, safety behaviour, pulse, and blood pressure. To strictly investigate Cognitive Defusion's effects, this study used a comparison group and they had thought distraction techniques. 50 speech-anxious students were randomly assigned to the two treatment groups. After the first speech task, participants received Cognitive Defusion treatment or thought distraction treatment and the second speech task followed. Right before and just after the two speeches, participants measured blood pressure and pulse. Following the two speeches participants completed each questionnaire. Results showed that Cognitive Defusion techniques were more efficient in decreasing negative automatic thought believability, belief in feared consequence and systolic blood pressure which measured just after speech than thought distraction techniques. In this regard the present study suggests that even in a short intervention, Cognitive Defusion techniques can reduce negative automatic thought believability and anxiety response of speech anxiety.

The present study examined the acceptance strategy affects on emotional responses in suppressors. Suppressors are defined as those who are reported low level of anxiety but exhibit heightened physiological reactivity to unpleasant stimuli. Suppressors and nonsupressors were randomly assigned to one of two conditions. Participants in the experimental condition listened to a rationale for accepting emotion and the other participants in the control condition listened to an article from a science magazine. Then all participants watched a negative emotion-provoking film. Self-report measurement and physiological measurement(Skin conductance level) of emotion were obtained before, during, and after the film. The result obtained was that suppressors reported a lower level of negative emotion than nonsuppressors. But there was no difference between suppressors and nonsuppressors in skin conductance level. The participants in the acceptance condition had an increased acceptance level and willingness. For the physiological result, after listening to the acceptance rationale there was a significant decrease in skin conductance level in nonsupressors but not in suppressors. The clinical implications and limitations of this study were discussed as well as future directions.

Background: The USPACE Young Adult Mental Health Unit at St. Vincent’s Private Hospital has been funded in response to both an emerging need for youth specific psychiatric treatment, and in recognition that early intervention in the course of mental illness can help prevent "collateral damage" to social and occupational functioning in later adulthood (McGorry and Purcell 2009). Operating on what is largely an adult private health model, and consisting of both inpatient and day programs, our aim has been to develop clinical programs that are tailored to the specific needs of young adults. In particular we hoped to minimize pathologising; to assist in the developmental tasks such as individuation and identity formation and provide young adults with knowledge, skills and experience to support them to develop psychological flexibility. We have also had the task of developing a program that is engaging, accessible and relevant to adolescents and young adults alike, with different disorders, backgrounds and histories. Further, we have re-examined practices in psychiatry which regularly promote experiential avoidance such as the provision of PRN medication in response to emotional distress. Methods: We chose to adopt an Acceptance and Commitment Therapy model based on the growing evidence of efficacy across a wide range of psychiatric disorders as well as its reputed face validity. A clinical program was developed in which four 60 minute groups are offered each day. Each day incorporates a theme covering the ACT processes of present moment awareness, cognitive defusion, self-as-context, acceptance, values and committed action. The Outcome Rating Scale and Session Rating Scales (Miller, Duncan & Johnson, 2002) were used to collect data for each session. Education was provided to nursing staff on the model and the use of PRN medication was observed over a 12 month period. Results: We will report data for the 12 months in which we have been open across inpatient and day program clinics. From this cohort we have a sample of pre/post data measuring psychological distress and experiences of the psychological interventions. We will also offer some descriptive data and give comment to emerging therapeutic themes as well as anecdotes on challenging the mainstream use of PRN medication in response to distress. Conclusion: The challenges described above represent the redevelopment of the model of mental health specifically for the treatment of adolescents and young adults, for whom diagnosis is often unclear and life is commonly complicated. The adoption of a model which avoids pathologising negative thoughts and uncomfortable emotions is, in our opinion, a vital aspect of promoting resilience, independence, a healthy identity and improved functioning in this cohort. Challenging common place practices such as provision of PRN is complicated by practicalities of ward milieu and safety. Further research is required to address these issues.

Background: According to the theory of Acceptance and Commitment therapy, psychological flexibility is deeply associated with mental health and various psychopathological conditions. The target of this cross-sectional study was to analyze the difference in the amount of psychological flexibility between healthy and depressed persons, and also to compare the mutual dependencies between the different dimensions of psychological flexibility during depression. Methods: A comparison of diagnostically depressed patients (n=105) to their age, gender and education matched healthy controls (n=105) was made. Psychological flexibility was evaluated using self-reported questionnaires. The results achieved so far have shown that the depressed reported significantly smaller amount of psychological flexibility (Mann Whitney U –test). Moreover, the similarity test of correlations between groups has shown differences in dependency between mindfulness skills and negative thoughts. Conclusions: The findings of the present study highlight that the lack of acceptance and mindfulness skills have an important role when developing treatments for depression. Keywords: Depression, psychological flexibility, experiential avoidance, Acceptance and Commitment therapy.

The purpose of this study was to evaluate how the investigation of verbal behavior in clinical behavior analysis has been conducted in Brazil. For that, this study performed a historical revision of Brazilian dissertations and theses related to the subject and carried out from 1968 to 2011. The aspects investigated include: (a) number of dissertation and thesis related to the subject, (b) thesis advisor, (c) type of research (descriptive or experimental), (d) line of research (basic, applied, conceptual and historical), (e ) theme, (f) research problem, (g) theoretical and philosophical bases used in the explanation of verbal behavior (Skinner, 1957, 1986; Sidman & Tailby, 1982, or Hayes, Barnes-Holmes & Roche, 2001), and ( h) methodology (experimental or descriptive). In total, 24 dissertations and ten theses related to the subject were identified, totaling 34 studies. The Universidade de São Paulo produced the largest number of studies (10). Other major research centers identified were: PUC-SP (nine studies), UFPA (eight studies), SCU (four studies), UNB (two studies) and UFSC (one study). The most recurrent themes were: operant control of verbal behavior, private events, and categorization of verbal responses. With regard to the theoretical framework, only one research followed the paradigm of stimulus equivalence (Sidman & Tailby, 1982), all others were based on the theoretical framework of Skinner (1957,1986). No study was based on Relational Frame Theory (Hayes, Barnes-Holmes & Roche, 2001). These data indicate that, unlike what was observed by Alvarez (2006) in Brazil, the third wave of behavioral therapies have not been yet established as a target of scientific research. The results obtained in this research allow to say that the study of verbal behavior – in Brazil – in the clinical field still is very incipient if compared with the total number of studies produced in Behavior Analysis (1.010 studies) or in the clinical field in general (104 studies). Possibly, both methodological difficulties involved in the study of verbal behavior and in conducting research in the clinical setting discourage researchers to undertake work in the field.

Difficult situations in which teachers face their own barriers in order to develop effective teaching interventions might occur in the school context. Psychological flexibility has been shown to predict ability to learn new skills at work, job performance, and mental health (Bond and Flaxman, 2006). Cognitive fusion and experiential avoidance interfere with psychological flexibility, which refers to contacting the present moment fully and, depending upon what the situation affords, acting in accordance with one's chosen values. The efficacy of ACT group intervention in educational settings has been empirically investigated. Results suggest significant improvements in valued living and mindfulness, and a decrease in experiential avoidance for special education staff (Biglan et al, 2013). The aim of our project was to develop, implement, and evaluate an ACT-based intervention to increase teacher's psychological flexibility. The intervention consisted of three, once weekly, 120-minute ACT group sessions. Measures of psychological flexibility (Acceptance and Action Questionnaire - AAQ), cognitive fusion (Cognitive Fusion Questionnaire -CFQ), general mental health (General Heath questionnaire - GHQ) and job satisfaction (Job Satisfaction Scale - JBS) were administered. Preliminary data of this pilot project will be discussed.

19. Valued action and well-being: Reciprocal relationships across the transition from high school to early adulthood
Primary Topic: Edu. settings
Subtopic: Values, Adolescents
Kathryn Williams, University of Wollongong
Joseph Ciarrochi, University of Western Sydney

Well-being promotes positive outcomes, which may include the ability to live according to one’s values; conversely, values-congruent living may be a source of well-being. The current longitudinal study tested reciprocal relationships between subjective well-being and the extent to which values are seen as personally important, pressured by others, activated, and successfully enacted. Participants were 468 young people (51.9% female) who responded to questionnaires in the final year of high school (Grade 12) and again approximately one year later. Regression analyses showed that life satisfaction predicted increasing value importance, activity and successful enactment. Valued action was not antecedent to well-being, when baseline levels of well-being were controlled. Positive changes in well-being over time were correlated with increased value importance, decreased pressure and greater success in enacting values. The findings build on a small body of research exploring the reciprocal interaction of well-being and valued action, and have implications for clinical interventions in ACT.

20. Treatment drop out in third wave cognitive-behavioral therapies: A systematic review and meta-analysis
Primary Topic: Other
Subtopic: Treatment Drop-out
Penelope Constantinou, University of Cyprus
Patrisia Nikolaou, University of Cyprus
Maria Karekla, University of Cyprus

Treatment dropout is one of the most crucial issues that a therapist has to face on a daily basis. The negative effects of premature termination impact the client who is usually found to demonstrate poorer treatment outcomes (Cahill et al., 2003). To date there has not been a systematic examination of drop out effects among third wave CBT treatments. The purpose for this study is to conduct a meta-analysis in order to review variables associated with treatment dropouts so as to assist with decreasing the negative impacts of treatment drop out on third wave of CBT treatment clients. A literature search was undertaken using six electronic databases and references of retrieved articles. 309 articles were identified for possible inclusion, while 71 of them met all inclusion/exclusion criteria. The variables associated with dropouts will be presented and discussed, including recommendations for researchers and practitioners and potential directions for future research and practice.

Purpose: This study investigates the effect of behavior activation (BA) with value clarification (VC) on (a) achievement ratios or repertoires of daily goal behavior as valued action and (b) mental health, or general health, anxiety, and depression. Method: Forty-two undergraduate students were randomly assigned to one of the conditions (BA protocol group or BA protocol with VC group), and a pre-post design was used. Both groups established their own goal behavior; however, those in the BA with VC group clarified their value before setting their goal behavior. Results: Compared to participants who received only BA protocol, after five months, there was no superiority of BA protocol with VC in increasing achievement ratios or repertoires of goal behavior and improvement in mental health. Discussion: Future research needs to examine the effects of multiple procedures, including other ACT components and acceptance or mindfulness, for improvements in quality of life.

Working as an interpreter is associated with high levels of stress and anxiety often due to the uncertainty that linguistic, environmental, interpersonal and intrapersonal factors contribute to rise in a stressful context. A common goal of many interpreters is to seek strategies that help manage emotions and arousal. In this view through such strategies great performance could be achieved and burn-out disorder prevented. We designed a pilot cross-over study to evaluate if an Acceptance and Commitment Therapy-based treatment increases coping with stress and anxiety and consequently the quality of the translation performance in a group of students of the School for Interpreters at IULM University (Milan, Italy). Students were randomized in 2 groups, one experimental and the control group. The experimental group attended 2 experiential sessions that focused on the role of the mind in increasing the importance of stressful factors and on values-oriented actions and daily 15-minute mindfulness-based sessions in a period of 3 months. The control group was shifted to the training after an adequate period of time. Translation performance and psychological measures related to anxiety, stress and psychological flexibility were collected before and after treatment. Preliminary results will be shown.

Indigenous youth have suicide rates up to five times higher than their non-Indigenous counterparts and are less likely to seek help due to shame, stigma, and lack of services in rural and remote communities. Mobile phone usage amongst Indigenous youth is high therefore technology may address help seeking barriers. Acceptance and Commitment Therapy principles align well with values of Indigenous culture, thus it is hypothesised that ACT may be efficacious in reducing suicidal ideation amongst Indigenous youth. A self-help, ACT based tablet app that caters for low literacy has been developed and will be trialled with individuals experiencing suicidal thoughts. Participant suicidality and mental health scores will be compared across 1) groups (intervention versus wait list control), with the intervention group predicted to have lower scores 2) and time (baseline, pre, post and follow up), with post app usage scores predicted to be lower than those prior to app usage.

The current study evaluates the validation of an ACT-related measure in the Greek-speaking population. As the empirical evidence for the ACT-based therapeutic interventions continues to grow, the importance of examining the processes or mechanism of change using psychometrically valid and reliable measures is paramount. The Avoidance and Inflexibility scale (AIS; Gifford et al., 2002), is a 13-item measure that assesses the link between private triggers related to inflexible behaviors in smoking and smoking cessation of individuals. The AIS was translated (and back-translated) and adapted in Greek and administered to high school students (M= 560, age=14.79, SD=1.058) in the context of a larger study. An exploratory factor analysis with principal components extraction and an oblique rotation showed a two factors solution accounting for 65.1% of the total variability. The AIS resulted in a two-factor theoretically meaningful solution with subscales for avoidance and inflexibility related to smoking experiences. A reliability analysis showed a Cronbach’s alpha coefficient of .92 for both factors. Based on the results, AIS appears to have adequate internal consistency in the Greek speaking population. In conclusion, the Greek AIS is a useful tool in evaluating psychological avoidance and inflexibility among adolescent smokers. Theoretical and clinical implications will be also discussed.

Relational Frame Theory (RFT) suggests that the temporal relational framing included in the self-rule enables us self-control. The purpose of the current study is to identify whether the Self-Control is related to the transformation of stimulus function in accordance with the temporal relating. Eighteen undergraduate students participated in this study. They were exposed to a more than / less than relational task, which involved the tests of the derived relations and the transformation of stimulus function. After relational task, they completed the delay discounting questionnaire, investigated self-control choice. Participants who passed the test showed lower discounting rate than participants who failed the test. Results revealed that the participants who passed the test preferred self-control choice in delay discounting questionnaire. We discussed about the role of the temporal relational framing in the self-control from the perspective of RFT.

26. Validation of the Child and Adolescent Mindfulness Measure in a Greek-Speaking Adolescent Population
Primary Topic: RFT
Subtopic: Validation of a Measure
Orestis Kasinopoulos, Ph.D. Candidate, University of Cyprus
Vasilis Vasileiou, Ph.D. Candidate, University of Cyprus
Stella Savvides, Ph.D. Candidate, University of Cyprus
Maria Karekla, Ph.D., University of Cyprus

It is of great importance to examine the psychological mechanisms of change behind ACT, a therapy that is increasingly becoming an evidence-based intervention. The Child and Adolescent Mindfulness Measure (CAMM) has been recently constructed and validated by Greco, Baer and Smith (2011) using an American adolescent sample. In this study, we evaluate the validation of both the long (25 - item) and short (10 - item) versions of CAMM in a Greek-speaking population. The 5-Point Likert scale of CAMM was first adapted in Greek using back-to-front translation and was then administered to high school students coming from 4 different high schools across Cyprus with age range between 15 and 18 (Mage= 16.00, S.D.= .85). An exploratory factor analysis (EFA) on the 25 - item measure, with principal components extraction and an oblique rotation resulted in a seven-factor solution with eigen values greater than 1.0 and cumulatively accounting for 66.60% of the variance likewise in the Greco, Baer, and Smith study. A reliability analysis indicated a Cronbach’s alpha of 0.90. Another EFA was conducted on the short 10-item scale and confirmed very high loadings from .43 to .79 for a single factor accounting for 65.2% of the variability (cronbach’s alpha = .91). According to the results, both versions appear to be valid and useful for assessing mindfulness skills in the Greek speaking adolescent population. Theoretical, clinical and practical implications for using the shorter version will be discussed.

Following previously reported training based on frame of coordinations (Linch and Cuvo, 1995) a fifth grade 9 year old girl with a IQ at the lower limits for normality and identified by teachers as having difficulties on fraction (e.g. 3/4) and decimal tasks (e.g. 0.75) was trained to match pictorial representations of fractions (B comparison stimuli) to printed counterpart fraction ratios (A sample stimuli), and to match printed decimals (C comparison stimuli) to pictorial representations of counterpart quantities (B sample stimuli). After testing for symmetry, transitivity and equivalence three twelve-stimuli classes emerged. In a generalization paper-and-pencil test two eight members X (printed fraction) and Y (printed decimal) classes relations (XY and YX) were also tested. Then another relation AD (match fraction ratios to dissimilar fraction ratios of equal value) was trained (and DA) and CD relations were tested. The CD generalization test assessed generalization of fraction and decimal matching to new combinations of previously employed stimuli. Though the replication of Linch and Cuvo (1995) study is limited to only one subject the results were replicated including the same difficulties of transferring stimulus function to the paper-and-pencil test. The same procedure was applied to teach other arbitrary relations (description of the problem - operation - description of the math rule) to solve math problems. Increment in standard math tests showed that after the training the subject moved from the 15th to the 41th percentile. A number of advantages related to the effectiveness per time of training ratio along with the limits of the study will be discussed.

The poster presents the current situation of contextual behavioral science (specifically, ACT) in Poland and possible obstacles to its further development. In order to improve the process of ACT dissemination we did an online survey concerning several issues. Professionals interested in ACT were asked questions about their motives for learning ACT, what prevents them from using ACT in their practice, what are the main barriers and facilitating factors in further ACT dissemination in Poland. It was revealed that the insufficient number of literature in Polish is the most often indicated obstacle to further ACT development. On the other hand, focus on the improving overall quality of life and not on the symptoms was indicated as the most important quality of ACT within the small Polish sample studied. Further results are presented together with conclusions for effective dissemination of ACT in Poland.

29. The Impact of Experiential Training versus Didactic Training on Experiential Avoidance, Thought Suppression, and Stigma in Graduate Students
Primary Topic: Superv., Train. & Dissem.
Subtopic: Training
Sylvia Spyrka, M.A., The Chicago School of Professional Psychology
Sandra Georgescu, Psy.D., The Chicago School of Professional Psychology

Stigma toward mental illness remains a large barrier to seeking treatment for individuals who need it most. However, recent literature suggests that stigma may continue to be maintained by mental health professionals within the therapy room. Unwillingness to experience uncomfortable thoughts and feelings on the side of the therapist such as those related to lack of progress or treatment failure may contribute to poor client outcomes. While current training in psychology addresses mental health stigma as part of their overall diversity training, most of this work is didactic in nature and fails to directly target the experiential avoidance process underlying stigma. Few studies have directly assessed the impact of experiential training on experiential avoidance in graduate students. In the present study, data that included measures of experiential avoidance, thought suppression, and stigma was retroactively reviewed from experiential and didactic clinical psychology graduate-level courses at three time points. Analyses showed that experiential training decreased experiential avoidance at post-training and 4-month follow-up. Measures from the experiential training group initially showed an increase in thought suppression post-training but no overall change at the 4-month follow-up. Experiential training's effect on the believability of stigmatizing beliefs was nearing statistical significance at the 4-month follow-up. In comparison, results from the didactic group showed no change on any measure. Results suggest that experiential training is a viable option to decrease overall experiential avoidance which has been linked to reductions in stigma, therapist burnout, and improved therapeutic outcomes. Limitations of this pilot study include small sample sizes and follow-up numbers.

A key challenge in clinical psychology training is how to include self-care training in an already overloaded curriculum to address elevated stress among clinical psychology trainees evident from anecdotal and research evidence. This poster describes the development of a university Doctoral level course in Acceptance and Commitment Therapy (ACT) that integrates the acquisition of ACT competencies and self-care skills. The outcomes of seven evidenced-based developmental phases are described: (1) Literature review on stress & self-care in students; (2) Investigation of stress levels in students. (3) Investigation of the effectiveness of ACT to reduce stress, and enhance therapist attributes and skills, and self-care skills; (4) Investigation of student views on using ACT in clinical training. (5) Investigation of student perspectives on improvements to clinical training; (6) Curriculum design and implementation; (7) Course evaluations. In summary, data will be presented that supports the effectiveness of integrating ACT into clinical psychology curriculum to train students in therapist competencies and self-care skills. Further, it provides support for innovative evidenced-based and student-informed teaching and learning strategies particularly suited to clinical psychology training contexts. This course received the 2012 Faculty of Social and Behavioural Sciences Award for the Enhancement of Student Learning, at The University of Queensland.

A qualitative study aimed to find perceived supervision needs of a group of behavioral therapists was conducted. Twelve therapists participated in a structured ACT and DBT based group supervision and answered an open questionnaire about the supervision elements they found to be most important and useful for their clinical practice, their perceived supervision needs at the beginning and ending of supervision were also assessed. The questionnaire was structured according to different developmental, CBT and role models of supervision. Participants' answers were coded and used to develop a new supervision program. The new model was discussed with therapists and modeled according to their satisfaction. This paper presents the qualitative data found in the study and describes the new model of supervision developed.

Based on the paradoxical effect of experience avoidance, Acceptance and Commitment Therapy advocated radical acceptance towards psychological events. However, the conclusion of experience avoidance is mainly based on suppression and should not be over-generalized. Distraction could be considered as avoidance, but turning attention away is essentially different from the suppression and it is compatible with acceptance in theory. Empirical studies also implied that focused distraction with positive content could be effective on emotion regulation. Loving-kindness meditation (LKM) has been used for regulating negative emotions with the principle of equanimity for a long time in Buddhism, and it could be extracted as a focused and positive distraction. Previous studies showed that the effectiveness of brief LKM without acceptance was comparable with mindfulness skill. Future studies should distinguish distractions from suppression and combine LKM with the idea of acceptance, and this will deepen our understanding on the balance between acceptance and change.

33. Does worldview impact experiential avoidance in social situations? A pilot examination of the effect of values on this relationship
Primary Topic: Theory & Philo.
Subtopic: Social Anxiety, Culture, Experiential Avoidance
Gabriela L. Alshafie, San Jose State University
Jennifer Gregg, Ph.D., San Jose State University

Recent research has examined emotional avoidance and anxiety sensitivity in the pathogenesis of anxiety-related problems. Intense psychological distress related to social situations relates to behavioral and emotional avoidance. Investigations on the differences between collectivistic and individualistic cultures are vast, however the findings are inconsistent. Although there is research investigating emotional avoidance and social anxiety, research regarding the applicability of the concept of emotional avoidance is limited for populations that identify with collectivistic characteristics. The present study focuses on the relationships between emotional avoidance, culture and social anxiety sensitivity and how these constructs may contribute to the pathogenesis of social anxiety. The moderating effect of individualistic/collectivistic worldview will be examined in the relationship between emotional avoidance and social anxiety disorder symptoms in a study examining a values-based intervention for negative social feedback.

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